Mental Health: What Cost Data Are Important?

Carolyn S. Dewa, MPH, PhD

Full Professor, University of Toronto Head, CREWH, CAMH

Senior Scientist/Senior Health Economist, SER, CAMH

Main Points

•  Different perspectives require different costs

•  Some cost data are not available, unless through primary data collection

•  Primary data collection can provide important insights

Total costs, definition

Two key cost data questions when you do a project:

•  What perspective?

•  What items should be included based on that

perspective?

Total costs, math •  Common perspectives include: societal, gov’t,

patient and caregiver…

•  Societal Total Cost (TCsocietal) is •  TCsocietal = TCgov’t + TCpatient + TCcaregiver

•  TCgov’t = TCMOH + TCnon-MOH

Most of the time…

•  TCsocietal = TCgov’t + TCpatient + TCcaregiver

Becomes •  TC = TCMOH + TCnon-MOH + TCpatient + TCcaregiver

•  TCMOH = p1q1+ p2q2

+ … + pmqm+ pm+1qm+1

+ … + pMqM.

•  TCMOH =Σpiqi + 0

(e.g., community programs)

Main points

•  Different perspectives require different costs

•  Some cost data require primary data collection

•  Primary data collection can reveal insights

Not easily available data

There are some cost data that are hard to find •  Community service use

•  “Non-health” health items (e.g., healthcare at a shelter)

•  New programs

Cost Study

•  Typically, when comparing costs between a NEW

and OLD way of doing things, we test

•  Is TCNEW = TCOLD?

OR

•  Is ΔTC = 0?

•  What if one takes a societal perspective, but uses

only easily accessible data?

Cost study (missing data)

•  ΔTC = ΔTCMOH + ΔTCnon-MOH + ΔTCpatient +

ΔTCcaregiver

Assuming ΔTC = ΔTCMOH is like assuming

•  ΔTCnon-MOH =ΔTCpatient =ΔTCcaregiver = 0

Plus, there may still be parts of TCMOH that are not

accessible in administrative data sets

Key issue

•  Is it a bad thing to assume:

ΔTCnon-MOH = ΔTCpatient = ΔTCcaregiver = 0 ?

•  In mental health economics, it is important to check because mental health care is not exclusively hospital or physician based

Main points

•  Different perspectives require different costs

•  Some cost data require primary data collection

•  Primary data collection can reveal insights

Consider a Case: The Matryoshka Project

Examined the effects of enhanced funding in Ontario for

specialized community mental health programs on continuity of

care

The study focused on the continuity of care of clients in two

types of specialized programs:

(1) court support programs (CSP) and

(2) early intervention programs for psychosis (EIP)

EIP Programs

•  All developed using the guidelines and standards

of the International Early Psychosis Association

•  All meet the Ontario Ministry of Health and Long-

Term Care’s EIP Program Standards

•  Members of EPION, the network of the 56 EIP

programs serving Ontario

The Matryoshka Project

For this case, we will examine the service use of two groups of

clients enrolled in early intervention programs (EIP):

Group 1 (Long Timers) = Enrolled in an EIP for > 12 m (n = 45)

Group 2 (Short Timers) = Enrolled in an EIP for < 12 m (n = 122)

Question: Is there a difference in the use of services and supports

based on length of involvement in EIP?

Rationale for the Two Groups

•  12-month time frame is a time frame for a typical fiscal year --- salient for decision maker budget cycle

•  Time frame informative for a decision maker who must decide how to distribute scarce public resources among multiple sectors for a budget year.

•  Comparison of enrollment time offers insight into potential changes in resources used by client groups by enrollment period – suggests impact of costing time horizon.

The Matryoshka Project Data sources: self-report, case manager, program records

Data collection instruments:

•  Hospital and Emergency Department Use Questions

•  Medication Log

•  Matryoshka Service Needs Profile

•  Physician visits (Primary care and psychiatry)

•  Community support services (i.e., vocational, social/recreational, counselling)

•  Housing Questionnaire

•  Legal Contacts Questionnaire

Annual Mean Costs Total by Perspective

> 12 m < 12 m ∆C

MOH (without Community) $12,364 $10,786 $1,578

MOH + Community $13,445 $12,045 $1,401

MOH + Community + Non-MOH $14,132 $13,569 $563

MOH + Community + Non-MOH + Patient + Ins $15,679 $15,875 ($197)

Caregiver Contributions Annual Mean Caregiver Contributions

Transportation $103

Clothing $7

Medication $461

Mental health care $200

Rent $73

Utilities $317

Phone $32

Damage to property $65

Other $797

TOTAL $2,055

Discussion

•  Will not know if a cost item will show an important

difference without collecting and testing.

•  These items were useful in the case study

•  Medication and Insurance

•  Community Mental Health Services

•  Caregiver contributions

Conclusion

•  If we don’t advocate for collection of data, there

won’t be resources for it.

•  If we don’t collect the data that allow for cost

estimation, we won’t know what we are missing.

•  Including a range of costing perspectives

acknowledges the breadth of the effects of mental

health on both a health and a social level.

References Dewa, C.S.; Jacobson, N.; Durbin, J.; Lin, E.; Zipursky, R.B.;

Goering, P. Examining the Effects of Enhanced Funding for Specialized Community Mental Health Programs on Continuity of Care. Canadian Journal of Community Mental Health. 29(Suppl 5): 23-40, 2010.

Dewa, C.S.; Trojanowski, L.; Cheng, C.; Hoch, J.S. Potential Effects of the Choice of Costing Perspective on Cost Estimates: An Example Based on Six Early Psychosis Intervention (EPI) Programs. submitted to Canadian Journal of Psychiatry.